Inflammation is a defense reaction caused by infection or tissue damage. The aim of this process is to eliminate the inflammatory stimulus and protect the surrounding tissue from further damage making it necessary for the survival of the host. A defect in this system can severely affect the integrity of the organism and may be fatal. This is demonstrated in patients with hereditary or acquired immune deficiency. Neutrophil depletion can have detrimental effects in some disease models, but is beneficial in others (Henson and Johnston Jr., 1987; Weiss, 1989). The reduction of neutrophil recruitment in disease models elicited by bacteria resulted in decreased bacterial clearance and reduced survival (Craig et al., 2009). The same observation can be made in patients suffering from leukocyte adhesion deficiency (LAD). This disease is characterized by a defect in leukocyte extravasation, resulting in an inappropriate inflammatory response to injury or infection (Etzioni, 2010). Patients with this disease suffer from recurrent bacterial infections and have a reduced life expectancy (Etzioni, 2010).

Neutrophil granulocytes represent an important cellular component of the innate immune system and are recruited following an inflammatory stimulus in a coordinated sequence of events into inflamed tissue (Ley et al., 2007). The leukocyte recruitment cascade consists of different steps including capturing, rolling, slow rolling, adhesion, crawling, and other activation events prior transmigration (Ley et al., 2007). Leukocyte capturing and rolling is mediated by selectins (Ley et al., 2007), whereas slow leukocyte rolling and adhesion is predominantly mediated by integrins interacting with their ligands expressed on endothelial cells. Integrins are members of a large family of conserved adhesion receptors, which occur in a low affinity conformational state on circulating leukocytes. Selectin and immunoreceptor engagement and chemokine binding to their receptors activate signaling pathways leading to the activation of integrins (inside-out signaling). During adhesion, engaged integrins can signal into leukocytes (outside-in signaling), which stabilizes adhesion and initiates transmigration. The activation of neutrophils during the recruitment process is mediated by different mediators including selectins, chemokines, and integrin-mediated outside-in signaling.

Selectin engagement activates different signaling pathways leading to tyrosine phosphorylation, cytoskeletal rearrangement, β₂-integrin activation, cytokine secretion, and transcriptional activation. It has been shown that P- and E-selectin engagement induces β₂-integrin activation and reduces the rolling velocity on P-selectin/E-selectin and ICAM-1 (Zarbock et al., 2007b; Kuwano et al., 2010). Selectin engagement induces LFA-1 activation in a Syk (spleen tyrosine kinase)-dependent manner (Zarbock et al., 2007b). E-selectin engagement induces the phosphorylation of the Src kinase Fgr and the ITAM (immunoreceptor tyrosine-based activation motif)-containing adaptor proteins DAP12 and FcRγ (Zarbock et al., 2008a; Yago et al., 2010). DAP12 and FcRγ subsequently recruit and activate the tyrosine kinase Syk (Zarbock et al., 2008a). In neutrophils from Fgr^−/− mice and Lyn^−/−/Hck^−/− mice, DAP12, and Syk phosphorylation does not occur following E-selectin engagement (Zarbock et al., 2008a). In this signaling pathway, SLP-76 and the Tec family kinase Bruton’s tyrosine kinase (Btk) are located downstream of Syk, whereas the signaling pathway downstream of Btk divides into a phosphoinositide 3-kinase (PI3K)γ- and PLCγ2-dependent pathway (Mueller et al., 2010; Block et al., 2012). Following E-selectin engagement the small GTPase Rap1 is activated downstream of PLCγ2 (Stadtmann et al., 2011). CalDAG-GEFI (Rasgrp2) and p38 MAPK are crucial signaling molecules between PLCγ2 and Rap1a (Stadtmann et al., 2011).

During rolling, leukocytes are exposed to different chemokines and chemoattractants presented on inflamed endothelial cells. Binding of chemokines to their receptors on leukocytes activates complex intracellular signaling networks which modulate integrin activation and eventually lead to leukocyte adhesion mediated by binding of leukocyte integrins to their counter-receptors expressed on the endothelial cell surface.

Chemokine receptors are specific G protein-coupled receptors (GPCRs) on the cell surface and form specific subgroups depending on the binding capacities for members of distinct chemokine families. Chemokines are subdivided into different families depending on their structure characterized by the relative position of the first two cysteine residues of the chemokine representing the determining factor for the chemokine family classification (Baggiolini et al., 1994). For chemokines of the CC-chemokine family, the first two cysteines are adjacent to each other, whereas the first two cysteines in CXC chemokines are separated by one amino acid. Two chemokines are described so far showing a different positioning of their cysteines. Lymphotactin is characterized by the occurrence of only two cysteines and in fractalkine, the first two cysteines are separated by three amino acids (CX₃C; Kelner et al., 1994; Bazan et al., 1997). Until now, 10 receptors for CC-chemokines (CC-chemokine receptors, CCRs), seven for CXC chemokines (CXC chemokine receptors, CXCRs), and one CX₃C chemokine receptor (CX₃CR) are described (Murphy, 2002; Burns et al., 2006). Chemokine receptors on the cell surface of neutrophils are exposed to different chemokines during rolling on the inflamed endothelium. Following binding of the chemokine to its receptor, intracellular signaling cascades are activated resulting in integrin activation (Zarbock et al., 2012). Neutrophils express different chemokine receptors on their surface, like CXCR1, CXCR4, CCR2, and CX₃CR1, but for CXCR2 many different important functions are described. CXCR2 was cloned for the first time in 1991 from the human cell line HL-60 (Murphy and Tiffany, 1991). High affinity ligands for CXCR2, which is also expressed on other immune cells like mast cells, monocytes, and macrophages, are CXCL1, 2, 3, 5, 6, 7, and 8 (Olson and Ley, 2002). The most potent ligand of CXCR2 is CXCL8 as well as cleavage products of this chemokine (Van Damme et al., 1989). CXCL8 was first described and characterized as a product with chemotactic characteristics in the supernatant of LPS-stimulated human mononuclear cells in 1988 (Matsushima et al., 1988).

There is an important difference between human and murine neutrophils concerning chemokine receptor expression on the surface of neutrophils. Human neutrophils express CXCR1 and CXCR2, whereas murine neutrophils only express CXCR2, even if there are some recent reports about murine CXCR1 homologs (Fu et al., 2005; Moepps et al., 2006). High affinity ligands of CXCR1 are CXCL6 and 8 (Wolf et al., 1998). CXCL8 is the major CXCR2 ligand in humans, but in some cases, CXCL8 also binds to and mediates some functions via CXCR1. Rodents do not express CXCL8 (Reutershan, 2006).

Following adhesion, integrins may activate different signaling pathways that regulate several cellular functions including cell motility, polarization, respiratory burst, phagocytosis, proliferation, and apoptosis (Abram and Lowell, 2007). Integrin clustering and ligand-induced allosteric conformational changes likely initiate outside-in signaling and signalosome formation. The efficient protein tyrosine kinase (PTK) recruitment and activation of various signaling pathways require the formation of signalosomes (Ley et al., 2007). The two Src family kinase members Hck and Fgr are required for transducing LFA-1- and Mac-1-mediated outside-in signaling (Giagulli et al., 2006). However, these two Src family kinases are not required for chemoattractant-triggered upregulation of LFA-1 affinity and leukocyte arrest (Giagulli et al., 2006). Leukocyte adhesion strengthening can be abolished by blocking β₂-integrin-mediated outside-in signaling (Giagulli et al., 2006). Additionally, by eliminating WASP (Sato et al., 2012), the GEFs VAV1 and VAV3 (Gakidis et al., 2004), or PI3Kγ (Smith et al., 2006) representing important signaling molecules of leukocytes, adhesion strengthening can be blocked.

Chemokine receptors are normally composed of 340–370 amino acids and show a 25–80% amino acid homology (Olson and Ley, 2002). GPCRs are seven-transmembrane proteins and consist of an α-subunit and a βγ-complex whereas the classification of these receptors depends on their α-subunit. Neutrophils express G_s-, G_i-, and G_q-family members with G_i-proteins representing the most important G proteins on neutrophils. This subclass mediates almost all pro-inflammatory effects of chemoattractants and can be subdivided into different subunits (Gα_z, Gα_o, Gα_i1, Gα_i2, and Gα_i3; Wilkie et al., 1992). With pertussis toxin (PTx), Gα_i-signaling with the exception of Gα_z-signaling can be blocked. Leukocytes abundantly express Gα_i2 and Gα_i3 (Jiang et al., 2002). A study by Zarbock et al. (2007a) demonstrated an important role for Gα_i2 for chemokine-induced neutrophil arrest in in vitro and in vivo models. A study using Gα_i2 deficient mice showed that Gα_i2 in non-hematopoietic cells is involved in leukocyte migration into the lung in an allergy model and after LPS application, whereas Gα_i2 in leukocytes is involved in regulating chemotaxis in response to chemokines (Pero et al., 2007). Gα_i3 regulates neutrophil migration via GIV (Gα − interacting vesicle-associated protein; Ghosh et al., 2008), redistributes and localizes at the leading edge of the cell during the cell migration process (Ghosh et al., 2008). A number of Gβγ-complexes can be formed, due to the fact that leukocytes express five different β-subunits and 12 γ-subunits (Wettschureck and Offermanns, 2005).

Chemokine receptors are special GPCRs and share some structural characteristics like an NH₂-terminal domain which is part of the chemokine binding site (Olson and Ley, 2002). They also have a conserved sequence in the second intracellular loop consisting of 10 amino acids (Olson and Ley, 2002) and share a characteristic cysteine within each extracellular domain and a short basic third intracellular loop (Murphy et al., 2000). The N-terminus of chemokine receptors which is characterized by a tyrosine sulfation motif (Murphy et al., 2000) is not important for the ligand binding affinity, however this domain is important for receptor triggering (Murphy et al., 2000). Recent studies made remarkable progress in the reconstruction of secondary and tertiary structures of GPCRs. Specialized methods like X-ray crystallography and electron microscopy revealed new insights into GPCR structures (Unger and Schertler, 1995; Pebay-Peyroula et al., 1997).

CXCR1 and CXCR2 are both Gα_i-coupled proteins and 78% of their amino acid sequences are identical (Reutershan, 2006). Divergent regions carrying the differences between the two receptors are the N-terminus, the C-terminus, the second extracellular loop, and the fourth transmembrane domain (Nasser et al., 2007). These regions are probably responsible for functional differences between CXCR1 and CXCR2 which will be mentioned later on. CXCR2 is a member of the rhodopsin-like family of GPCRs, however the crystal structure of CXCR2 is not revealed, yet (Murphy et al., 2000).

Binding of a chemokine to its receptor may induce many different cellular responses like adhesion, migration, and chemotaxis including cellular shape changes, reorganization of the actin cytoskeleton, upregulation of integrin expression, and integrin activation (Baggiolini, 1998).

The activation of a GPCR by the engagement of a chemoattractant results in an activation of the associated G protein, which dissociates into the GTP-bound Gα-subunit and the Gβγ-complex (Zarbock and Ley, 2008). Both, the α-subunit and the βγ-complex, are able to activate different signaling molecules (Figure 1).

Following dissociation, the α-subunit inhibits some adenylyl cyclase isoforms leading to a decrease of intracellular cAMP-levels and cAMP-dependent protein kinase activity (Sunahara et al., 1996). Gα_i-subunits are also involved in the activation of small GTPases following GPCR activation. Gα_i-dependent Ras activation induces the activation of phosphatidylinositol-3-kinase (PI3K) by directly binding to the catalytic subunit of PI3K (Rodriguez-Viciana et al., 1994).

The βγ-complex is able to activate PI3Kγ and the two phospholipase C (PLC) isoforms β₂ and β₃ (Camps et al., 1992; Hirsch et al., 2000). PLC hydrolyzes phosphatidylinositol 4,5-bisphosphate to generate inositol trisphosphate (IP₃), which mobilizes calcium from non-mitochondrial stores, and diacylglycerol (DAG), which activates Ca²⁺-independent and Ca²⁺-dependent protein kinase C (PKC; Berridge and Irvine, 1984). Different PKC isoenzymes are required for activating cytotoxic effector functions of neutrophils (Mayer et al., 1996). PLC β₂-deficient neutrophils show enhanced chemotaxis and increased leukocyte recruitment in response to fMet-Leu-Phe (fMLP), but reduced chemoattractant-induced Ca²⁺ release and macrophage-1 antigen (Mac-1) upregulation (Jiang et al., 1997). Murine neutrophils deficient in both, PLC β₂ and PLC β_3, show impaired chemokine-stimulated O₂⁻ formation (Li et al., 2000). It has also been shown that PLC is involved in chemokine-induced α₄β₁-integrin activation and monocyte adhesion (Hyduk et al., 2007). A recent study by Stadtmann et al. (2011) demonstrated that the GEF CalDAG-GEFI, which requires Ca²⁺ and DAG for activation, is necessary for chemokine-induced neutrophil arrest in vivo.

PI3Kγ, which can be activated by different βγ-subunits, catalyzes the phosphorylation of phosphatidylinositol-3,4-bisphosphate (PIP₂) to phosphatidylinositol-3,4,5-trisphosphate (PIP₃) which is able to bind to proteins containing pleckstrin homology domains, leading to downstream signaling (Varnai et al., 1999). Such an example for PI(3)Kγ-dependent downstream signaling is the activation of Akt, which clusters at the leading edge of migrating neutrophils (Figure 1; Servant et al., 2000).

The small GTPases of the Rho-family are also activated downstream of PI3Kγ (Servant et al., 2000). Neutrophils express Rac1 and Rac2 and both molecules regulate the migration of neutrophils, whereas Rac2 is also involved in the regulation of the respiratory burst (Glogauer et al., 2003; Gu et al., 2003). The activation of Rac is mediated by guanine nucleotide exchange factors (GEFs) by exchanging GDP for GTP. Different GEFs are expressed in neutrophils and these molecules are involved in Rac activation like the GEFs of the P-Rex family which are directly activated by the Gβγ subunit and PIP₃. In contrast, Vav family GEFs in neutrophils are activated in a Syk and Src kinases dependent pathway (Figure 1; Welch et al., 2002; Fumagalli et al., 2007). A recent study by Lawson et al. (2011) demonstrated that P-Rex-1- and Vav-1-deficiency mediates severe defects in GPCR dependent neutrophil activation. Another important molecule called DOCK2 (dedicator of cytokinesis 2), can also regulate the activity of Rac1 and Rac2 (Kunisaki et al., 2006) and influences cell polarity changes and translocation speed (Kunisaki et al., 2006). Activated Rac activates p21-activated kinase (PAK), which can subsequently induce the phosphorylation of extracellular signal-regulated kinase 1/2 (ERK1/2), p38 mitogen-activated protein kinase, and c-Jun N-terminal kinase (Kim and Dinauer, 2001; Fumagalli et al., 2007).

CXCR2-triggered signaling uses the same molecules described above, but a recent study by Wu et al. (2012) revealed a new mechanism for the coupling of CXCR2 to its downstream signaling molecules. They showed that the PDZ scaffold protein Na⁺/H⁺ exchanger regulatory factor-1 (NHERF1) couples CXCR2 to its downstream effector PLC-β2, forming a macromolecular complex, through a PDZ-based interaction (Wu et al., 2012). Disruption of this complex led to a decrease of intracellular calcium concentrations on the molecular level, and suppressed neutrophil chemotaxis and migration on the cellular level following chemokine stimulation (Wu et al., 2012).

There are differences described for the signaling cascades downstream of either CXCR1 or CXCR2 activation. In contrast to CXCR2 dependent signaling, phospholipase D gets activated and neutrophils are primed to perform respiratory burst following CXCR1 activation (L’Heureux et al., 1995; Jones et al., 1996). Due to these data, it is likely that the activation of the two receptors play different roles under inflammatory conditions.

Neutrophils are essential for maintaining innate immune surveillance under normal conditions, but also represent a major contributor to tissue damage during autoimmune processes. Therefore, neutrophil homeostasis and recruitment are tightly regulated. CXCR2 plays a critical role in the regulation of neutrophil homeostasis (Eash et al., 2010; von Vietinghoff et al., 2010; Mei et al., 2012), because CXCR2-deficient mice demonstrate mild neutrophilia and severe neutrophil hyperplasia in the bone marrow (Shuster et al., 1995). A recent study demonstrated that CXCR2-signaling is a second chemokine axis that interacts antagonistically with CXCR4 to regulate neutrophil release from the bone marrow (Eash et al., 2010).

During inflammation, leukocyte extravasation from the blood vessel into inflamed tissue is one of the hallmarks of the immune system. However, leukocyte recruitment has to be tightly regulated, as excessive leukocyte extravasation may lead to the deterioration of the integrity of the organism and may worsen acute and chronic inflammatory diseases. Different chemokines, which are released during inflammation, direct leukocytes to the site of inflammation. The chemokine receptor CXCR2 and its ligands have been implicated in a variety of inflammatory disorders making it an interesting target for therapeutical approaches (Seitz et al., 1991; Boyle Jr. et al., 1998; Kurdowska et al., 2001; Bizzarri et al., 2006; Reutershan, 2006; Chapman et al., 2009). In several inflammatory disease models, blocking, or eliminating CXCR2 substantially reduces leukocyte recruitment, tissue damage, and mortality. Based on the physiological importance of CXCR2, selective CXCR2 inhibitors have been developed that are now being tested in clinical trials. Due to the structural similarities between CXCR1 and CXCR2 or an influence by the activity of one of these receptors on the activity of the other, CXCR2 manipulation may affect CXCR1 dependent functions. This possibility has to be tightly controlled, but experiments in the murine system do not include these cross-reactivities because murine neutrophils do not express CXCR1. The following part summarizes current knowledge about CXCR2 in inflammatory diseases and discusses its potential as a pharmaceutical target.

As described above, CXCR2 and CXCR2 ligands are involved in many processes which can influence different disease conditions. Therefore, controlling CXCR2 and therewith CXCR2 dependent processes can be powerful therapeutic mechanisms. Affecting CXCR2 dependent pathways is possible in different ways. Distinct strategies including N-terminally modified chemokines, antibodies, and small-molecule antagonists were tested.

Several low molecular weight CXCR2 antagonists have been developed and tested in different in vitro and in vivo models. The first low molecular weight CXCR2 antagonist was described in 1998 in a study by White et al. (1998). The described antagonist was a selective non-peptide antagonist of CXCR2 and inhibited CXCL8 and GROα dependent neutrophil chemotaxis in vitro. Therefore, it was suggested as a potential tool for therapeutic application (White et al., 1998). Following the identification of this compound, a class of diarylureas was tested in different disease models for possible therapeutic usage.

Another type of CXCR2 inhibitors are allosteric inhibitors, which block CXCR2 function by blocking receptor signaling instead of chemokine binding. In the beginning of allosteric inhibitor investigation, a concentration-dependent inhibitory effect on CXCL8 function, such as neutrophil chemotaxis was reported (Souza et al., 2004). Non-steroidal anti-inflammatory drugs known as ketoprofen and ibuprofen were reported to be potent inhibitors of CXCL8 dependent neutrophil chemotaxis (Bizzarri et al., 2001). Subsequently, a series of potent allosteric CXCR2 inhibitors were described. Another non-competitive allosteric inhibitor is Reparixin (or Repertaxin), which specifically blocks CXCR1 or CXCR2-mediated neutrophil migration in vitro without affecting other receptors (Bertini et al., 2004). It was previously demonstrated that Reparixin inhibits CXCL8 induced neutrophil activation and blocks the increase of intracellular free calcium, elastase release, and production of reactive oxygen intermediates (Bertini et al., 2004). The application of this inhibitor in different disease models demonstrated that Reparixin is able to mediate beneficial effects in a bacteria-induced peritonitis, a venom-induced lung injury, and different models of ischemia-reperfusion-injury (Bertini et al., 2004; Souza et al., 2004; Cugini et al., 2005; Garau et al., 2005; Coelho et al., 2007). A recently published study by Zarbock et al. (2008b) demonstrated that Reparixin attenuates ALI by reducing neutrophil recruitment and vascular permeability. Because of suboptimal pharmacokinetic characteristics of Reparixin, related compounds were tested and DF 2162 was reported to have similar effects as Reparixin, but better pharmacokinetic characteristics (Coelho et al., 2007; Cunha et al., 2008; Chapman et al., 2009).

The pyrimidine series-based CXCR2 antagonist AZD-8309 has been clinically tested in different disease models. A recent report by Virtala et al. (2011) reported that AZD-8309 application reduced LPS-induced neutrophil recruitment and elastase activity about 50% in comparison to placebo application in a lower airway LPS model.

Different CXCR2 antagonists developed by GlaxoSmithKline were also reported to be able to inhibit chemokine binding to CXCR2, mediating decreased migration in response to CXCL1, 5, and 7 (Traves et al., 2004). Another antagonist was demonstrated to inhibit CD11b upregulation and shape changes as characteristics of neutrophil activation following stimulation with CXCL1 of neutrophils from COPD patients (Chapman et al., 2009). One of the antagonists of this group, SB-656933, was already tested in clinical trials of CF and ozone-induced tissue injury. In this study, oral administration of SB-656933 inhibited CXCL1-induced CD11b upregulation on neutrophils and reduced ozone-induced airway inflammation in a dose-dependent manner. This was quantified by neutrophil counts in the sputum following ozone challenge (Lazaar et al., 2011).

Another recent study reported that the CXCR2 antagonist SCH527123, which is a potent inhibitor of neutrophil activation and trafficking in animal models, is a potent inhibitor of ozone-induced neutrophil recruitment in a human clinical trial (Holz et al., 2010). SCH527123 treatment of healthy humans resulted in significantly lower sputum total cell and neutrophil counts as well as CXCL8 levels following ozone treatment in comparison to prednisolon or placebo treated study participants (Holz et al., 2010).

GSK1325756, a specifically designed CXCR2 antagonist, was already tested in a phase I clinical trial, determining the effects of GSK1325756 in healthy adult volunteers (www.clinicaltrials.gov, study number NCT01267006). In this study, blood parameters were checked in participants treated with either a placebo or GSK1325756. In another group the effect of food to the levels and outcome of GSK1325756 was investigated.

As CXCR2 is involved in the pathogenesis of many diseases, this receptor and its ligands are interesting targets for clinical trials. However, it has to be kept in mind that blocking CXCR2 can have beneficial but also harmful effects. Blocking CXCR2 inhibits the inflammatory response. Following bacterial or viral infections, the inhibition of the immune response can be very dangerous. Pathogens cannot be eliminated accurately, leading to dissemination of the pathogen and systemic infection. On the other hand, under sterile inflammatory conditions, for example following ischemia-reperfusion-injury, decreasing the neutrophil recruitment and the immune response can be beneficial. Further studies and clinical trials are necessary to further elucidate the exact effects of blocking CXCR2 and/or its ligands under different disease conditions.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.